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This is VAERS ID 276541

Case Details

VAERS ID: 276541 (history)  
Age: 12.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-03-29
Onset:2007-03-29
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:15
Entered: 2007-04-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Pregnancy test
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree AV block. CBC WNL. Glucose 104. DC with 24 hour Holter monitor.
CDC Split Type:

Write-up: patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


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